Does Your Sinus Infection Need Antibiotics?

Item number two on the “Choosing Wisely” campaign to educate doctors and patients on unnecessary tests is the toughest one of all- “Don’t routinely prescribe antibiotics for acute mild-to-moderate sinusitis unless symptoms last for seven or more days, or symptoms worsen after initial clinical improvement.”

For years doctors have known that the majority of sinusitis infections are caused by viruses. We know that antibiotics do NOT cure viral infections, only bacterial ones. Why, then, do many doctors continue to prescribe antibiotics for this problem? Why do patients ask for an antibiotic even when the doctor takes the time to explain that an antibiotic is unlikely to help? Americans spend over $5.8 BILLION health care dollars on this common diagnosis via 16 MILLION office visits and medication costs.

Have I ever prescribed antibiotics for this? You bet- especially on a Friday, or when a patient is headed out of town! BUT…let me explain why and how. As a busy mom, I understand the exasperation of a lingering runny, stuffy nose and headache, and the desire for a simple cure to “fix it”- whether those symptoms are mine or my husband’s or kid’s. If I take the time to schedule an appointment, show up, and wait because the doctor is running late, I want to get my money and time’s worth and be handed a cure. The doctor wants to be able to give you this cure. Both parties can feel like they are “doing something” when the doctor prescribes the antibiotics. And sometimes it seems that once we take that antibiotic, then, indeed the symptoms go right away. However, from good research, we know this is the exception, and not the rule.

Given all these factors, here is my approach. If I examine a patient and believe they have a mild to moderate sinus infection that has lasted only a few days, I frequently offer them two prescriptions: one for something to help with the symptoms (such as a drying antihistamine, if a runny nose is a major complaint, or a decongestant and something to break up mucus if they are stuffy with thick nasal discharge); and the second one a prescription for an antibiotic. BUT- I ask them not to fill the antibiotic prescription for a couple days, explaining why it is unlikely to help unless their symptoms drag on or they get signs of a secondary infection such as fevers or local pain in their teeth or forehead. I encourage them to hydrate till they float, and to use old -fashioned topical vapor rubs or sip spicy soups to open nasal passages. I have found that the vast majority of the time, when we follow up with our patient, they report they never needed to fill that second prescription (for the antibiotic) and we all feel as though we’ve done something productive.

BOTTOM LINE: Most sinus infections will resolve without antibiotics- talk with your doctor about treatment options that will help your symptoms, but don’t insist on an antibiotic.